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Interprofessional Patient Conference Worksheet Purpose of Conference: Before the team meets (completed by each professional)  Review the case  Identify potential concerns of the patient/family  Identify information or research required for your profession  Identify potential priorities for your profession in the case conference

Profession-specific priorities:

Notes:

1. 2. 3.

Preparation for interview (discussed prior to the patient’s arrival) Set priorities to address in interview:  Discuss identified priorities of each team member  Negotiate 1-4 team priority issues to address in the conference  Identify key team members for each priority

Priority #1

Priority #2

Priority #3

Priority #4

Names:

Names:

Names:

Names:

Clarify meeting processes: **Identify appropriate team roles required for each team member, in order to facilitate team process. **Not all roles may be employed in every meeting; however, assign roles to ensure that those process duties are filled when they are required. **All team members occupy both a team role, to contribute to team process, and a professional role.

Initiator: guides goal setting and facilitates meeting progress

Recorder: records the proceedings, provides notes to patient/family

Timekeeper: ensures that the team is on track and the meeting ends on time

Advocate: advocates for perspectives that are not heard, including the patient’s

Name:

Name:

Name:

Process Observer: comments on methods to enhance group process

Energizer: encourages and supports team members, where required

Participant: supports team members in their roles, where required

Name: Participant: supports team members in their roles, where required

Name:

Name:

Name:

Name:


Discuss:  How will the team clarify and address the patient/family’s goals?

Notes:

 How will the team clarify their roles for the patient/family?  How will process issues be addressed during the meeting? (e.g. if the team is running out of time)  How will the team know if the meeting is successful? Tentative Agenda (set in advance of the meeting): ** Align agenda with priorities, recognizing flexibility will be necessary to ensure that the patient’s goals are heard and addressed during the meeting Agenda:

Notes:

Follow-up required:


IP Patient Conference (Meeting Planning) Worksheet